Brief Answer:
Please provide more details, must avoid milk & its products if true allergy

Detailed Answer:
Hello sir,

Thank you for asking at HCM.

I went through your son's history and would like to know more about him as follows:

a. Since what age has he started reacting to milk products?

b. Can you please upload photographs of his skin lesions, if taken in past?

c. Can you please upload his SPT report? (Interpretation of SPT is done after considering sizes of positive and negative controls only; a size of 3 mm can be both negative or positive; sizes of reaction also depend on age)

d. Please attach other reports related to allergy, if any (total IgE, complete blood counts, etc)

e. Has he had any digestive symptoms - constipation, diarrhea, blood in stool, vomiting, etc? Any digestive symptom associated with milk?

f. Does he have any skin lesions when he has not taken milk/milk products?

g. At what age, milk was introduced to your son?

h. Does he have tendency to catch respiratory infections easily?

i. Does any one in his family (mother/father/siblings, etc) have any allergic disorder (nose allergy, asthma, skin allergy, food allergy, etc). If yes, please give details.

Please provide above information on follow-up. They will help me to understand your son's health problem in a better way.

At present, in relation to your query, I can provide you following helpful information:

1. Milk allergy is very common in children and it is possible to develop irritation, redness, itching, swellings, after taking milk/milk product, if the child is allergic to milk.

2. Montelukast (montair) has very good effects in allergic disorders, hence it is used to treat allergic problems. However, it is not a "curative" drug and it is not an alternative to milk/milk product avoidance.

3. If he is really allergic to milk, and only to milk, then he only needs to avoid milk and milk products. In that case, he needs medications only when he develops symptoms due to accidental/unknown ingestion of milk.

4. Regarding "cure" of milk allergy, as per modern medical science, 70% of the children outgrow milk allergy by age of 3 years, and 80% by age of 5 years of age. They do not react to milk any more and can take milk safely afterwards. However, till "spontaneous cure", it is best to avoid milk and milk products.

Hope above information will be helpful to you. If you have any query, please feel free to ask on follow-up. Also, please give the details that are asked above on follow-up.

Wish your son best of the health.

Thank you very much & best regards,

Dr Parin N Parmar, MD
Pediatric Allergist-Immunologist

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Brief Answer:
Questions answered and additional information

Detailed Answer:
Hello Mr XXXX,

Thank you for the follow-up.

I went through your details and reports, which suggest high possibility of milk allergy as every time he has had reactions after consuming milk containing products and on SPT, the highest reaction is seen with milk.

First, addressing your queries:

1) & 2) Please note again that montair is helpful when he has symptoms due to allergy.

To my milk allergy patients, I suggest them to always keep montelukast (montair) and an antihistamine like cetirizine or levocetirizine available with them. I advise them to give both these medications when he develops symptoms after consuming milk/milk products.

Milk products include - milk, curd, buttermilk, paneer, ghee, cheese, ice cream, milk cream, and others that are prepared from or contain any of these...

It is very common in XXXXXXX to consume "hidden milk proteins", even if parents are taking care to avoid milk products. Such examples are - chocolates containing milk proteins, biscuits containing milk proteins, some sweets containing milk or paneer or malai etc. So in such cases of unintentional milk intake, when followed by reaction, I suggest them to take montair and levocetirizine at home.

If reaction is severe (such as vomiting or drowsiness), one must immediately go to a pediatric hospital, of course.

Please note that montair is also a "preventive" drug that is advised to take daily when avoidance is not possible. But this is not ideal. For proven allergies, food avoidance is ideal. Montair does not "cure" allergy, taking it regularly helps to reduce severity of reactions, should patient accidentally take milk.

3) There is nothing such as a "course" of montair. As mentioned above, if one is able to avoid milk proteins, one does not need it. If one cannot, one should take it as long as one is allergic to milk.

For practical purpose, I suggest my such patients to take it for 2-4 weeks. It takes a few days for parents to learn what food items to avoid and mistakes are possible during initial weeks of milk elimination diet.

4) In allopathy, there is no "cure" for allergy. Allergy is very common in children and most of milk allergies improve by 3 years, if not, by 5 years. However, please note that 20% would still have milk allergy after 5 years, and it is uncertain when they would come out.

Immunotherapy (desensitization) is a possible option, practiced only by qualified allergists. However, I do not suggest immunotherapy to my patients before age of 3 years.

5) Allergy is an immunological problem. Immune system needs a balanced diet. Hence you should make sure that he gets foods from all 4 food groups: grains, nuts & seeds, green leafy vegetables, and fruits. Egg and fish are good from non-veg foods.

Please avoid/minimize food additives, fast food, etc as much as possible.

As one has to eliminate milk, children with milk allergies should take foods rich in calcium, vitamin D, and vitamin A. If your pediatrician thinks so, he can be given these vitamins as supplements. You can also check vitamin D levels in blood before considering supplementation.

6) Yes, plenty of options are available for children with milk allergy. Some of them are - soy milk, peanut milk, almond milk, coconut milk, etc. You can always find recipes of these alternatives from internet.

There are also some commercial hypoallergenic milk formulas available in market, which is tolerated by many milk allergic children. However, their availability is always inconsistent in XXXXXXX Please consult your pediatrician or allergist in your area, who may know which commercial preparations are available in your state.

If he is not allergic to soy, I would rather suggest him to begin any alternative milk immediately, rather than after taking montair for 2 months. He does not need to restrict any food he is not allergic to.

A few more important points:

a. Children receive proteins from mother's food via breast milk. Hence if the child has milk allergy, it would be best that his mother also restricts milk and milk products till she is breastfeeding the child. During this period, I would suggest taking calcium and vitamin D supplements to mother so that she would not become nutritionally deficient.

b. As managing milk allergy needs significant dietary modifications and is stressful for both children and parents, I always double confirm my patients by getting also blood test for milk allergy, in addition to SPT.

The blood test is known as "specific IgE to Milk Protein, using ImmunoCAP". It performed in many well-equipped and standardized laboratories and it is also performed by allergists.

Hope above information will be helpful to you.

Should you have any further query, please feel free to ask on follow-up.

Wish your son best of the health.

Thank you very much & best regards,

Dr Parin N Parmar

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